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Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation.

Publication ,  Journal Article
DeRose, JJ; Mancini, DM; Chang, HL; Argenziano, M; Dagenais, F; Ailawadi, G; Perrault, LP; Parides, MK; Taddei-Peters, WC; Mack, MJ; Glower, DD ...
Published in: J Am Coll Cardiol
May 21, 2019

BACKGROUND: The incidence of permanent pacemaker (PPM) implantation is higher following mitral valve surgery (MVS) with ablation for atrial fibrillation (AF) compared with MVS alone. OBJECTIVES: This study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS. METHODS: A total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117) or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI) (n = 62) or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality. RESULTS: Thirty-five patients received a PPM within the first year (14.4%), 29 (83%) underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multivalve surgery, and New York Heart Association functional (NYHA) functional class III/IV were independent risk factors for PPM implantation. Length of stay post-surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation) and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05) after adjustment for randomization assignment, age, and NYHA functional class. CONCLUSIONS: AF ablation, multivalve surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 21, 2019

Volume

73

Issue

19

Start / End Page

2427 / 2435

Location

United States

Related Subject Headings

  • Risk Factors
  • Pulmonary Veins
  • Mitral Valve
  • Middle Aged
  • Male
  • Humans
  • Heart Valve Diseases
  • Heart Atria
  • Female
  • Catheter Ablation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
DeRose, J. J., Mancini, D. M., Chang, H. L., Argenziano, M., Dagenais, F., Ailawadi, G., … CTSN Investigators, . (2019). Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation. J Am Coll Cardiol, 73(19), 2427–2435. https://doi.org/10.1016/j.jacc.2019.02.062
DeRose, Joseph J., Donna M. Mancini, Helena L. Chang, Michael Argenziano, François Dagenais, Gorav Ailawadi, Louis P. Perrault, et al. “Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation.J Am Coll Cardiol 73, no. 19 (May 21, 2019): 2427–35. https://doi.org/10.1016/j.jacc.2019.02.062.
DeRose JJ, Mancini DM, Chang HL, Argenziano M, Dagenais F, Ailawadi G, et al. Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation. J Am Coll Cardiol. 2019 May 21;73(19):2427–35.
DeRose, Joseph J., et al. “Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation.J Am Coll Cardiol, vol. 73, no. 19, May 2019, pp. 2427–35. Pubmed, doi:10.1016/j.jacc.2019.02.062.
DeRose JJ, Mancini DM, Chang HL, Argenziano M, Dagenais F, Ailawadi G, Perrault LP, Parides MK, Taddei-Peters WC, Mack MJ, Glower DD, Yerokun BA, Atluri P, Mullen JC, Puskas JD, O’Sullivan K, Sledz NM, Tremblay H, Moquete E, Ferket BS, Moskowitz AJ, Iribarne A, Gelijns AC, O’Gara PT, Blackstone EH, Gillinov AM, CTSN Investigators. Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation Ablation. J Am Coll Cardiol. 2019 May 21;73(19):2427–2435.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 21, 2019

Volume

73

Issue

19

Start / End Page

2427 / 2435

Location

United States

Related Subject Headings

  • Risk Factors
  • Pulmonary Veins
  • Mitral Valve
  • Middle Aged
  • Male
  • Humans
  • Heart Valve Diseases
  • Heart Atria
  • Female
  • Catheter Ablation